Glaucoma Is More Than Just RNFL Scans

In complex glaucoma cases, reliable management depends on using multiple structural metrics.

By: James L. Fanelli, OD, FAAO

Optometric Management February 13, 2026

Clinical Report: Glaucoma Is More Than Just RNFL Scans

Overview

Effective management of complex glaucoma cases requires a multifaceted approach that includes various structural metrics. The Bruch’s membrane opening-minimum rim width (BMO-MRW) emerges as a critical measurement when other metrics are compromised by conditions like epiretinal membranes.

Background

Glaucoma remains a leading cause of irreversible blindness, necessitating accurate diagnosis and management strategies. Reliance solely on retinal nerve fiber layer (RNFL) scans can lead to misinterpretation in complex cases, particularly when other ocular conditions are present. A comprehensive evaluation that includes multiple structural metrics is essential for effective patient care.

Data Highlights

No numerical data provided in the source material.

Key Findings

Conflicting data can arise between clinical examination and OCT findings in glaucoma management.
Bruch’s membrane opening-minimum rim width (BMO-MRW) is a reliable metric unaffected by conditions like epiretinal membranes.
Macular region evaluations, including total retinal thickness and ganglion cell layer measurements, can be distorted by ocular conditions.
Clinical judgment should integrate multiple metrics for accurate assessment of glaucoma stability and progression.
Long-term management of glaucoma patients benefits from a multimodal approach to diagnostics.

Clinical Implications

Clinicians should utilize a range of structural metrics beyond RNFL scans to enhance diagnostic accuracy in glaucoma. Understanding the limitations of each metric, especially in the presence of confounding ocular conditions, is crucial for effective patient management.

Conclusion

A comprehensive approach to glaucoma evaluation, incorporating various structural metrics, is essential for optimal patient care. This strategy aids in distinguishing true glaucomatous damage from artifacts caused by other ocular conditions.

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